Behavioral Health Benefits

Transcription

1 NEW YORK 2016 ISSUE III Behavioral Health Benefits New York Medicaid members have a variety of behavioral health benefits. These include coverage for behavioral health, alcohol and substance abuse, and smoking-cessation benefits. Here are some details about your benefits: You can get one outpatient behavioral health assessment without prior authorization. You usually need an intake assessment before a psychiatrist will prescribe medication. Most outpatient services and programs recommended through the assessment are also covered benefits. We cover eight smoking-cessation counseling sessions per calendar year. Community mental health centers offer the greatest variety of services. They usually have the most quickly available appointment slots. You may need to get prior approval before you get some treatments and services. Or you may need approval to continue getting them after you start. Authorization time varies from one to 14 days after receiving the request. We have a Customer Service line. The number is (TTY ). You may use this number to get help with finding a provider or program. You can also get help making an appointment for service. We also have a behavioral health crisis line for emergencies. You can call Customer Service to reach this line. Or you can call

2 Family Planning and Planning for a Healthy Pregnancy There are questions to ask when choosing a birth control method. How effective is it? Is it affordable? Is it readily available? Your health care provider can help answer some of these questions. When you are ready to have children, plan for a healthy pregnancy. Get the prenatal care you need. Don t skip your dental checkups while you re pregnant. Getting dental care is good for you and your baby. Sources: Office on Women s Health, U.S. Department of Health and Human Services, Pregnancy, retrieved from index.html MedlinePlus, Birth control and family planning, retrieved from gov/medlineplus/ency/article/ htm Your Rights as a WellCare Member As a WellCare member, you have the right to: Get information about the organization, its services and its providers; Get information about member rights and responsibilities; Be treated with respect and dignity; Have your privacy protected; Work with providers to make decisions about your health care; Talk about treatment options for your conditions, without thought of cost and benefit coverage; Voice complaints about the plan or the care it provides; and Make suggestions about the plan s member rights and responsibilities policy. You have responsibilities as a member to: Give information that the plan and its providers need to provide care; Follow instructions for care that you have agreed on with your doctor; Understand your health problems; and Help set treatment goals that you and your doctor agree to. You may have more rights and responsibilities. Find them in your Member Handbook. 2 Member Newsletter

3 Communicating With Your Doctors for Better Coordination of Care Sooner or later everyone sees more than one doctor. All of your doctors should have the information they need to coordinate your care. That way, your doctors or hospitals can work together to give you the right care. Going from one doctor to another or from the hospital back home is like the start of a road trip. It is important not to leave until you know your destination. Are you going to a new doctor? Your regular doctor should talk with the new doctor to explain why you need the added care. Are you going home from the hospital? A plan should be in place for your care at home. Here are some steps you can take to help coordinate your care: Carry with you important information about yourself, your condition, your doctor and your pharmacy. Bring a list of your medications to your appointment with your new doctor or hospital. Do you have a family member or friend who helps take care of you? Bring him or her with you to your appointment. Write a list of questions before your appointment or hospital stay. Ask about anything you do not understand. When you leave the hospital make an appointment with your doctor within seven days. Bring your hospital discharge plan to your appointment. Source: Center for Advancing Health, The Handoff: Your Roadmap to a New Doctor s Care, retrieved from prepared-patient/prepared-patient-articles/ the-handoff-your-roadmap-to-a-newdoctor-care Member Newsletter 3

4 Are You At Risk for Hepatitis C? Hepatitis means inflammation of the liver. It is usually caused by a virus. The hepatitis C virus (HCV) infects about 25,000 people each year. HCV is spread by contact with the blood of an infected person. It can cause diseases and cancer of the liver. People can be infected with HCV for years and have no symptoms. The Centers for Disease Control and Prevention recommends a one-time screening for HCV. This is for all people born between 1945 and Injection drug users have the highest risk for infection. This is true even if they injected only once many years ago. Other risk factors include: Getting a transfusion or organ transplant before 1992; Getting dialysis; and Getting clotting factor produced before Want to find out if you have HCV? Get screened. There is no vaccine to prevent hepatitis. But it is curable in many cases. Have you learned that you re infected? Get proper medical care. You and your health care provider will decide whether treatment is right for you. Source: The New York State Department of Health, Hepatitis C, retrieved from communicable/hepatitis/hepatitis_c Your overall well-being includes having access to basic resources. That s why we believe in connecting people with social services such as food banks or meal delivery, housing assistance, financial assistance, transportation and education. 4 Member Newsletter

5 Protect Yourself from STDs Are you being safe when it comes to sexually transmitted diseases (STDs)? Many STDs, like chlamydia and HIV, don t have symptoms. That s why it s important to get tested. You can take steps to protect yourself and those close to you from STDs. Use a male or female condom. Avoid sex with someone who uses drugs. Avoid drugs and alcohol. They can keep you from protecting yourself. Only have sex with one partner whose STD status you know. You can get confidential testing and treatment for STDs. These are available at many local and county health clinics. Find a clinic near you. Go to gov/diseases/communicable/std/clinics. You can also call the CDC s National STD hotline. The number is (TTY ). Free HIV Testing The New York State Department of Health offers HIV testing. It s free and confidential. It s available to anyone ages 12 or older. Find a testing site near you. Go to sites.htm. You can also call the New York State HIV Hotline: AIDS (2437) English SIDA (7432) Spanish Sources: The New York State Department of Health, Sexually Transmitted Diseases (STDs), retrieved from ny.gov/diseases/communicable/std; and STD and HIV Facts, retrieved from Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Stop by our website, You ll find our Preferred Drug List (PDL). You can learn about drugs we ve added or removed. You ll also find changes to any drug requirements or coverage limits. You can also call us for updates. Member Newsletter 5

6 Kids, Self-Harm and Suicide: What Parents Need to Know Research shows that more and more kids are visiting hospitals because of injuries they ve inflicted on themselves. This is called self-harm. Most people who self-harm don t intend to kill themselves at first. But pre-teens and teens who hurt themselves face a higher risk for suicide later on. Compelled to Cut Why do kids damage their own bodies? They may do it to: Take risks and rebel; Stand out or be accepted by peers; Seek attention; or Show anger, frustration, hopelessness or suicidal thoughts, especially if they feel they can t talk about their feelings. Many may have serious psychiatric problems. Some might feel release and relief after selfharming. For others, the injuries only make problems worse. Spot These Red Flags Guns are the most popular self-harm tool among boys. Cutting and piercing with sharp objects are most common among girls. Other ways kids can hurt themselves include: Burning with cigarettes, matches or candles; Pulling out hair; Intentionally falling; and Suffocating or poisoning themselves. Watch for warning signs in children of all ages. Red flags include: Unexplained cuts, bruises or scars; Wearing long sleeves or pants even when it s hot; and Having sharp objects around for no reason. Talk with your kids about respecting and valuing their bodies. Do you think your child is self-harming? Then talk with a doctor or behavioral health professional right away. Treatment can include ways to manage stress without resorting to violence. Source: StayWell 6 Member Newsletter

7 Member Information Update Check our website often for new and updated information. You will find the Member Handbook at NewYork. The handbook has information on: Benefits and services and exclusions from coverage; Pharmaceuticals management procedures (if you have the pharmacy benefit); Co-payments and other charges you might be responsible for; Benefit restrictions about out-ofnetwork and out-of-service area providers; Language assistance; Filing claims; Doctors in our network; Primary care services; Specialty, behavioral health and hospital services; After-hours care; Emergency care when to use 911 or go to the emergency room; Getting coverage when out of the service area; Filing complaints; Filing appeals; and How we evaluate new technology. You may ask for hard copies of information from our website. Call Customer Service. The number is on the back page. You may leave a voic message after hours. Calls are returned within 24 business hours. You may also call to ask for materials in another format. This includes different languages, large print and audiotapes. There is no charge for this. Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. It is based on third party sources. We are presenting it for your information only. It does not imply that these are benefits covered by WellCare. Also, WellCare does not guarantee any health results. You should review your plan or call Customer Service to find out if a service is covered. Call 911 or your doctor right away in a health emergency. Member Newsletter 7

8 WellCare of New York, Inc. 1 New York Plaza, 15th Floor New York, NY PRSRT STD U.S. POSTAGE PAID WELLCARE HEALTH PLANS Para solicitar este documento en Español, llame al Servicio al Cliente al (TTY ). NY034279_CAD_NEW_ENG Internal Approved WellCare 2016 NY_06_ In This Issue We re pleased to bring you another issue of Member Focus. In this issue we cover behavioral health benefits, as well as coordination of care and your member rights and responsibilities. There s much more inside. Take a moment to explore. As always, we wish you good health. Numbers to Know We re just a phone call (or click) away! Call Customer Service: TTY Monday Friday, 8 a.m. to 6 p.m. Or visit Nurse Advice Line: hours a day/7 days a week 10867MG